| Eclipse Mental Health Services | |
|
817 S Elm Pl Suite C Broken Arrow OK 74012-5369 | |
| (918) 940-4734 | |
| (918) 940-4737 |
| Full Name | Eclipse Mental Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 817 S Elm Pl, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Dustin O'leath Hayes (PRESIDENT) |
| Authorized Official Contact | 9189404734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eclipse Mental Health Services 817 S Elm Pl Suite C Broken Arrow OK 74012-5369 Ph: (918) 940-4734 | Eclipse Mental Health Services 817 S Elm Pl Suite C Broken Arrow OK 74012-5369 Ph: (918) 940-4734 |
| NPI Number | 1124561113 |
|---|---|
| Provider Enumeration Date | 11/23/2016 |
| Last Update Date | 04/06/2020 |
| Medicare PECOS PAC ID | 7113203654 |
|---|---|
| Medicare Enrollment ID | O20170417001405 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124561113 | NPI | - | NPPES |
| 200678490A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 5382 (Oklahoma) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Dustin O Hayes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184981144 PECOS PAC ID: 0244465516 Enrollment ID: I20131023001078 |
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